Good day everyone. My name is Marie-Josée Lemieux. I am the Vice-President of the Ordre des psychologues du Québec. I am accompanied by Mr. Beaulieu, Secretary General and by Mr. Lorquet, the order's lawyer.
The primary mission of the Ordre des psychologues du Québec is to protect the public. Our association ensures quality of services provided by its members, promotes development of the profession and defends access to psychological services. Currently, our order has 8,150 members working either in health care, in private practice or the public health care network, in educational institutions or for major companies.
We are aware that the Standing Committee on Veterans Affairs is concerned with access to psychological services for victims of trauma related to operational stress, and concerned with a future shortage of psychologists. So it is a pleasure for us to have accepted the committee's invitation to come and provide information on the following issues: the reasons for the increased educational requirements providing access to the profession of psychologist in Quebec; an overview of training for psychologists within the Province of Quebec; the changes in the numbers of psychologists given the need for a Ph.D. degree and the aging of the population; as well as strategies to be considered to encourage more psychologists to develop expertise in treating veterans.
For the past two years, psychologists have been required to have a doctorate. This standard came into force following a regulatory change in July 2006. The new regulation on degrees was amended by the Quebec government, pursuant to section 184 of the Professional Code of Quebec, following an extensive consultation process particularly with the Quebec Professions Board, universities, the Quebec Department of Education and the Quebec Department of Health.
Under the old regulations, the order licensed psychologists who had a master's degree. The new regulation means that only those holding doctorates can become psychologists. Students are now enrolling in doctoral studies after they get their undergraduate degree.
Over the past few decades the evolution and diversification of practices in the area of psychology has meant an increase in initial training needs in order to properly prepare psychologists to treat diversified clienteles and ensure a constantly changing range of services. For many years, young psychologists coming out of university did not feel sufficiently prepared to deal with the demands of the profession, particularly with regard to practical training. They were then able to access additional training to complete their training.
Six studies conducted during the 1990s indicated that students graduating in the field of psychology and their trainers felt, first, that the theoretical and practical training they received was insufficient and that young psychologists did not feel prepared to exercise their profession without having additional training. Second, they felt that their university courses and activities should focus more on clinical practice. And finally, they felt that the amount of practical training time dedicated to serving clients should be extended and there should be a greater number of hours spent with clients as well as a greater number of hours spent under supervision.
In light of those facts, in order to address those deficiencies, the majority of psychologists sought out complimentary practical training or individual supervision related to the fundamental aspects of their practice once they graduated from university. A large proportion of them said that they felt sufficiently prepared to go into solo practice and sufficiently competent in psychology only when that additional training had been completed.
In light of those facts and pursuant to its mandate to protect the public, the Ordre des psychologues du Québec had a duty to propose a solution that would take into account the changing knowledge and the diversification of professional services provided by psychologists.
Consequently, towards the end of the 1990s, the Ordre des psychologues du Québec, in partnership with Quebec universities, proposed developing a training model based on seven professional competencies. Furthermore, the Order also recommended increasing the number of hours devoted to practical training during the university course work. So, the former standard, which allowed for a 600-hour internship was increased to 2,300 hours. The universities which had up till then been providing professional programs at the master's level, felt that these new requirements could only be offered within a doctoral degree program.
Furthermore, having a Ph.D. standard based on competencies is widespread throughout North America. Most Canadian provinces, as well as most American states, require students to obtain a Ph.D. in order to independently practice this profession.
It should also be noted that the Canadian provinces have signed a reciprocity agreement allowing all psychologists to work anywhere in Canada. This agreement is competency-based, and was inspired by the Quebec training model.
During the consultations that preceded the adoption of the new regulation, various stakeholders consulted expressed some reservations and asked questions about the impact of making students obtain a doctorate on a future shortage of psychologists in Quebec.
At that time, the universities made the commitment to increase the number of spots in programs and to shorten their duration. As a result, since the 2006-2007 academic year, the year that the new regulation came into force, an additional 39 students were admitted into programs in Quebec, a 17% increase.
Furthermore, the Quebec government recently amended the Professional Code in order to give professional associations the regulatory tools they need to facilitate the recognition of foreign credentials. Furthermore, the Department of Immigration and Cultural Communities of Quebec is providing funding to the professional associations so that they can develop in partnership with the universities programs that ensure access to complementary training for candidates from outside Canada who apply to have their diplomas recognized.
The Ordre des psychologues du Québec, in partnership with the University of Sherbrooke, recently proposed a project to the Department of Immigration and Cultural Communities to develop a framework program for such candidates. This measure should help to facilitate access to professional training courses and, consequently, accelerate the licensing of immigrants.
Finally, the Ordre des psychologues du Québec is currently taking part in the round table bringing together the Quebec Professions Board, the Department of Health and Social Services of Quebec, and the Department of Education Recreation and Sports of Quebec in order to update occupational outlook information for health care and education and private practice.
Furthermore, Quebec currently has 2,300 psychologists working exclusively in the area of private practice. A poll conducted in 2005 by our association told us that a vast number of them are interested in a full-time or part-time position within the public network. The marked interest of psychologists in having a public sector position could be of interest to the Department of Veterans Affairs, which is concerned with ensuring ongoing services to veterans.
As I said earlier, the Ordre des psychologues du Québec currently has some 8,150 members, which is nearly half of all psychologists in Canada.
Over the past 10 years, the increase in the number of members has remained quite stable. The average increase in the number of psychologists was 200 a year. Of our more than 8,000 members, at the moment close to 2,000 of them provide care for people with post-traumatic stress disorder. Slightly over 4,500 members provide services for the treatment of anxiety-related problems. Close to 5,000 of them provide services to treat depression and almost 500 provide services for the treatment of alcoholism and drug addiction.
As regards a possible strategy, I should mention that there are a number of training options available in doctorate programs in Quebec universities. I am thinking particularly of options in clinical psychology, neuropsychology, children and families and work/organization, not to mention community psychology. It is mainly the professionals with training in clinical psychology who work with the victims of operational stress and their families.
Internships play an important role within the doctoral training program. Interns are students who do most of their practical training in clinics that specialize in treating trauma caused by operational stress. This can be a good way of ensuring the availability of services geared to the needs of veterans.
For example, the Quebec government is currently considering offering scholarships for interns as a way of recruiting psychologists in areas of practice with the most limited resources. A scholarship program for interns could definitely be an effective way for the Department of Veterans Affairs to encourage students to show an interest in providing services for veterans. Clinical training with veterans would also enable students to develop specific expertise geared to the veterans' needs.
Grants for clinical research, in cooperation with the universities, is another possible way of improving the overall availability of services for veterans. The money being invested by the department to treat trauma resulting from operational stress definitely deserves support from clinical research so as to assess how effective it is and to improve practices.
That completes my presentation. We will be pleased to answer any questions you may have.
Welcome to our committee, and thank you for that particular presentation.
I believe it is fair to say that there's a lot more focus on this particular area within the military in the last number of years, and certainly with some of the studies, if we can call them that, that have been conducted around people returning from areas like Afghanistan. There is even more of a light being shone on the need for psychology or mental health within the military itself to help veterans and people currently within the military structure deal with certain situations.
We have to segue into this in some way, shape, or form. Your organization is the order of psychologists of Quebec, right? You are a regulatory body that develops standards and that type of thing. Do you have an advocacy role, as such? I see there's an association of psychologists of Quebec as well, which it seems to me would have more of an advocacy type of role apart from a regulatory approach. Is that fair to say?
A voice: There is no such association.
Mr. Todd Russell: According to our notes, there is an association of psychologists of Quebec that speaks on behalf of approximately 1,000 psychologists who have joined its ranks. That is differentiated in the notes from the Order of Psychologists of Quebec.
:
I see: in that case, if I may, I would like to add something.
We talked about scholarships. We understood from our discussion with Mr. Rossignol that you were looking for some ideas and strategies to get new psychologists. It is not up to us to tell psychologists that they should go to a particular location because there is a shortage there and too many psychologists somewhere else. That is not our job.
However, our members tell us that there is a serious problem at the moment involving the salaries paid to interns during their doctoral training. This is not true in most of the provinces. Most students in doctoral programs in psychology in Canada get paid for their work—either through a scholarship or in the form of a salary. That is not true in Quebec. The culture in Quebec is different.
When Mr. Beaulieu and I met with the Deputy Minister of Health last spring, she told us, that because of the danger of a shortage in some sectors, she was considering offering scholarships to attract students to take further training as psychologists in a particular sector or specialty. When we were talking about scholarships earlier, we were thinking of the Sainte-Anne Hospital, for example.
It is true that there is a specialty offered there in PTSD or operational stress, and this is part of the service provided to veterans. It could be a very good idea to offer scholarships to attract interns to specialize in services for veterans. In this way, they would develop within the system and be able to offer specialized services.
Would you like to add something, Ms. Lorquet?
:
The cultural aspect is very important.
[Translation]
I'll continue in French, if you don't mind.
Once psychologists start providing services, they are confronted with this cultural reality. That is when training occurs. The issue is how to draw psychologists in this service network. Initial training, internship... People can do one-year internship. For instance, they can spend a year at Sainte-Anne Hospital or in any of the OSI clinics in Canada. There are five of them at the moment, and there will soon be ten. It certainly is the way of the future, because young psychologists are trained on-site, they understand the culture, they are interested in this clientele. They are more likely to remain.
There's also the issue of ongoing training for psychologists already practising. Almost 2,000 psychologists in Quebec offer post-traumatic stress disorder treatment. Almost 2,000 psychologists offer this type of service in Quebec. It is probable that very few of them are trained to work directly with these clients, because they do not know them. That does not mean they cannot work with them, but they do not have a good understanding of the culture. I think ongoing training could certainly be of interest.
Ongoing training is not mandatory in Quebec. It may become so under a new bill, Bill 50. Through mandatory ongoing training, the Ordre will have oversight on the type of training offered to its members. If there were a need in Quebec to specialize and to provide specific training to our psychologists for them to work with veterans, we would certainly be open to doing so. We would be prepared to assess the content of this training, evaluate supervisors who provide the training, if there is such a need, of course. Sometimes, you create a need. You must start by discussing it and creating an interest. I think that is certainly one approach to consider.
:
My answer goes back to what we said earlier. There is basic training and ongoing training. However, I am under the impression that the clinics in Quebec, especially the one in Sainte-Anne-de-Bellevue, are well staffed in terms of professionals. They already have an acceptable number of psychologists. The Department of Veterans Affairs adequately subsidizes this provision of services. According to what I have been told, as demand increases in Quebec, services are made available and staff is hired. These services are not only available to the client, but also to his or her family and relatives.
You referred to firemen and policemen. These services are tailored to their needs, that is, people who have suffered trauma, regardless of the environment. In this respect, Quebec is very well equipped: 1,900 psychologists provide services related to post-traumatic stress. Of course, there are different kinds of post-traumatic stress, as undergone by members of the military and police officers, respectively. For victims of car accidents or street assault, the CSST, the SAAQ and VCI, as third-party payers, pay the psychologists who provide services to this clientele. The array of services available is quite broad.
We're talking about military culture. As I said earlier, it would perhaps be a good idea to establish dialogue and provide more information about this clientele. I think that the department has been doing so for the past 20 years, but there is still work to be done. In my opinion, psychologists in Quebec are prepared to do more. The role of the Ordre des psychologues, however, is nonetheless limited. Under our mandate, we can grant licences, oversee the practise of the profession and the skills of our members and take disciplinary measures. But we should not be expected to overstep the boundaries of our mandate.
I think that we are a major player in the field of psychology in Quebec. We can convey messages and facilitate the process of raising awareness about this clientele. In that regard, if we can help you out, we will be happy to do so.
:
As far as the paid internships are concerned, I'll tell you what the problem is, it's not rocket science. Each province is responsible for its own health care system. So Quebec has chosen its own model. Is it the good one? I'm not criticizing it. However, that's why it is extremely difficult to compare one province with another in the areas of health or education. These are provincial jurisdictions. That's why it is extremely difficult to draw comparisons.
The program you were asking questions about is precisely the one we are studying here. The Standing Committee on Veterans Affairs is trying to find ways to provide better services to three types of veterans: elderly veterans, that is, those 80 years old and over, those who participated in peace missions, and the younger veterans, especially those suffering from post-traumatic stress. We have to find ways to provide them with better treatment.
I am convinced that it would be a good idea for the Ordre des psychologues du Québec to meet with senior officials from the Department of Veterans Affairs. You said that there are enough psychologists in Quebec. If you draw the ratio, there are seven million Quebeckers and 8,000 psychologists, which represents about 0.01% of the population of Quebec.
In Afghanistan, there are 2,500 members of the Canadian Forces and 4,000 or 5,000 civilians on the ground, but there is only one psychiatrist and one nurse who has a certain amount of training in psychology or psychiatry, and then there are the chaplains, who save souls. That's all we have to treat our soldiers.
A little earlier, you asked whether we could focus on prevention. Yes, we can. We spend millions of dollars to train our soldiers in the United States for five or six months before sending them out on a mission. They are taught about post-traumatic stress for a couple of hours, they are told about the symptoms and the conditions. I am referring to what Dr. Chantal Descôteaux said; she is the Chief Medical Officer at CFB Valcartier.
I've been an MP for 11 years and it's barely been two years that the Department of National Defence has been quietly talking about psychological or operational injuries. The talk used to be all about nervous breakdown, semi-nervous breakdown, very nervous, not too nervous, all kinds of nervous breakdowns, but it only ever was nervous breakdowns. Sometimes, members committed suicide, which marks the unfortunate end of post-traumatic stress.
I've met with people my son's age who are suffering from post-traumatic stress. When I saw them, they were all “fucked up”—pardon my English—, they had “lost it”, they were on drugs, they were drunk, and they were divorced because their wives and children had left in fear, and it was really pathetic.
You have your work cut out for out. I am willing to help you make contacts. We could make the Department of Veterans Affairs more sensitive to the need to better train psychologists, to hire more of them, to have them work in isolated regions, not only in Quebec but in the rest of Canada as well. This is not an issue of politics or of country; this issue affects the health and future of our youth, these 25 or 30-year old kids who are all messed up.
That was my final, very emotional, comment. You can respond now. Thank you very much, that was terrific.